title: Comparative effectiveness and efficiency in peripheral vascular surgery.
abstract: BACKGROUND
  Elective peripheral vascular surgery provides quality outcomes that are of great benefit to patients, but have complications that result in severe morbidity and excessive costs.
  
  
  METHODS
  We studied elective carotid endarterectomy, aortofemoral bypass/aortic aneurysm repairs, and femoral-distal bypass surgeries among hospitals(N ≥ 20 cases) from 2002 to 2005 from the national Inpatient Sample of the Healthcare Cost and Utilization project. Adverse outcomes, mortality, and cost models were developed. Outlier hospitals were defined for excessive adverse outcomes (P < .005) and excess cost (P < .0005).
  
  
  RESULTS
  There were 43,700 carotid endarterectomy patients from 447 hospitals, 9,090 aortofemoral bypass/aortic aneurysm patients from 187 hospitals, and 14,453 femoral-distal bypass patients from 243 hospitals. Approximately 3% of hospitals were quality outliers, and 8% to 24% of hospitals were efficiency outliers by procedure.
  
  
  CONCLUSIONS
  Comparative effectiveness and efficiency modeling at the hospital level shows inefficiency and is responsible for 90% of excess costs. Overall reduced complication rates will further enhance cost reductions.
authors.affiliation: Michael Pine and Associates, Chicago, IL 60615, USA. dfry@consultmpa.com
authors.forename: Donald E
authors.initials: DE
authors.lastname: Fry
authors.forename: Michael
authors.initials: M
authors.lastname: Pine
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Jones
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Meimban
mesh_terms: D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000191:economics; D016894:Endarterectomy, Carotid / Q000191:economics; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000191:economics / Q000601:surgery*; D020379:Risk Adjustment; D016896:Treatment Outcome; D014481:United States; D058017:Vascular Grafting / Q000191:economics; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000401:mortality